Does 36901 require prior authorization?

No, 36901 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 36901?

Medicare facility rate: $147.30. Non-facility rate: $686.39. Work RVU: 3.28.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.28

Facility

$147.30

Non-Facility

$686.39

When an ABN is issued and liability is being transferred, a signed ABN Form CMS-R-131 must be retained in the beneficiary record; Part A MAC claims require occurrence code 32 and the ABN date.
The medical record must include the ordering provider's assessment related to the patient's complaint for the visit and relevant medical history.
Results of pertinent tests or procedures must be documented; for diagnostic tests, report the test result if known or otherwise the symptoms prompting the test.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

Claims for dialysis access maintenance billed to Medicare Part A or Part B should be submitted when coding conforms to the applicable Local Coverage Determination L34062 and applicable NCCI and OPPS coding/packaging edits.
For services that require a referring or ordering physician, claims must include the referring/ordering physician's name and NPI to be eligible for payment.
Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
Perform venous ultrasound to evaluate postthrombotic (postphlebitic) syndrome in patients with symptoms consistent with PTS (e.g., chronic leg pain, heaviness, swelling, itching, or leg ulcers).

L33693 — Peripheral Venous Ultrasound

J09

L37371 — Electroretinography (ERG)

J12

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

L35007 — Vestibular and Audiologic Function Studies

J12

L35434 — Oximetry Services

Ask Verity about documentation requirements, denial risks, or coverage in your state.